Individual
TASHADA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 PRIMERA BLVD STE 160, LAKE MARY, FL 32746-2168
(407) 585-0825
Mailing address
255 PRIMERA BLVD STE 160, LAKE MARY, FL 32746-2168
(407) 585-0825
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
28573
FL
376J00000X
Homemaker
Primary
28573
FL
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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